Supine hypotensive syndrome of pregnancy

Abstract

Since the first description of supine hypotensive syndrome in the 1950s, its potentially detrimental effects on otherwise healthy women during late pregnancy have become a persistent challenge in obstetric practice. Establishing a 158 left lateral tilt during labour and caesarean section is a fundamental principle of obstetric care, universally adopted and upheld by current guidelines and recommendations. Reassessment of the original landmark studies in the light of current physiological and anatomical knowledge questions adherence to this standard in clinical practice. The modern practice of providing vasopressor support during caesarean delivery under neuraxial anaesthesia appears to negate any potential negative effects of a maternal full supine position. Recent MRI studies provide evidence as to the cause of supine hypotension and the physiological effects of different maternal positions at term. This review highlights current data on the acute supine hypotensive syndrome in contrast to traditional knowledge and established practice.

Physiology of pregnancy and oral local anesthesia considerations

“…Blood pressure and cardiac output are also decreased, resulting in oxygen deprivation to the brain and uterus, which may lead to supine hypotension syndrome. Supine hypotension syndrome occurs in approximately 10% of pregnant patients and is usually characterized by hypotension, syncope, and bradycardia ( Massoth et al, 2022 ). The patient should be placed in a semi-supine position or told to lean 5° to 15° to the left (right hip elevation 10 to 12 cm) with a pad on the right lower back to move the uterus toward the aorta, which is less prone to collapse.…”

Geburtshilfliche Anästhesie

“…Bei diesen Patientinnen kann dann z. B. eine möglichst lange und betonte Linksseitenlage durchgeführt werden, die erst zum Hautschnitt für erleichterte Operationsbedingungen korrigiert wird [23]. Die Durchführung einer Sectio unter Anwendung einer Linksseitenlage, welche die V. cava tatsächlich entlastet, ist nach Auffassung der Autoren undenkbar.…”

Intravenous ondansetron for the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section: a randomized controlled trial

“…Supine hypotensive syndrome can lead to fetal hypoperfusion and affect the health of the mother and infant, so it is very important to take effective measures to prevent and treat supine hypotensive syndrome during cesarean section. Postural intervention is an effective measure for preventing and treating supine hypotensive syndrome during caesarean section, which is done by turning the woman on her side ( Kinsella and Lohmann, 1994) In addition, fluid preload and vasoconstrictors can effectively prevent the episode of hypotension after spinal anesthesia ( Massoth et al, 2022) .…”